Basic Information
| Provider Information | |||||||||
| NPI: | 1598380750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELK | ||||||||
| FirstName: | AURORA | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 PLATEAU AVE | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950606452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082648378 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1115 CAPITOLA RD | ||||||||
| Address2: | |||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950622844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314754055 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2020 | ||||||||
| LastUpdateDate: | 06/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 28794 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.